Verapamil: Uses, Dosage, and Side Effects Overview

Summary of Key Points

Verapamil is a prescription medication commonly used to manage high blood pressure, angina (chest pain), and certain heart rhythm disorders. It works by relaxing blood vessels and slowing the heart rate, which improves blood flow and reduces the workload on the heart. Verapamil is available in various forms and strengths. Always consult your healthcare provider before starting or adjusting your dose. You can also schedule a telemedicine visit with us for personalized care.

Names of Medication

US Brand Names: Calan, Calan SR, Verelan, Verelan PM

Generic Name: Verapamil

The generic name refers to the active ingredient in the medication, while the brand name is assigned by the manufacturer. In this case, Verapamil is the generic name.

Pharmacologic Category: Calcium Channel Blocker

Verapamil belongs to a class of medications known as calcium channel blockers. Other drugs in this category include Diltiazem, Amlodipine, and Nifedipine. These medications help relax the muscles of the heart and blood vessels, making them effective for treating conditions like high blood pressure and angina.

Verapamil Dosage

Verapamil is prescribed for various conditions, and the dosage may differ depending on the specific condition being treated. Always follow your doctor’s instructions and consult them before making any changes to your dose. If you need to speak with a healthcare provider, you can schedule a telemedicine appointment with us.

Verapamil for Hypertension (High Blood Pressure)

Initial Dose: 80 mg to 120 mg orally, 3 times a day.

Maintenance Dose: 240 mg to 480 mg per day, divided into 2 or 3 doses.

Length of Treatment: Long-term, as directed by your doctor.

Verapamil for Angina (Chest Pain)

Initial Dose: 80 mg to 120 mg orally, 3 times a day.

Maintenance Dose: 240 mg to 480 mg per day, divided into 2 or 3 doses.

Length of Treatment: Long-term, as directed by your doctor.

Verapamil for Atrial Fibrillation

Initial Dose: 240 mg to 320 mg per day, divided into 2 or 3 doses.

Maintenance Dose: 240 mg to 480 mg per day, divided into 2 or 3 doses.

Length of Treatment: Long-term, as directed by your doctor.

Verapamil for Supraventricular Tachycardia (SVT)

Initial Dose: 240 mg to 320 mg per day, divided into 2 or 3 doses.

Maintenance Dose: 240 mg to 480 mg per day, divided into 2 or 3 doses.

Length of Treatment: Long-term, as directed by your doctor.

Verapamil for Cluster Headaches

Initial Dose: 240 mg to 320 mg per day, divided into 2 or 3 doses.

Maintenance Dose: 240 mg to 480 mg per day, divided into 2 or 3 doses.

Length of Treatment: As directed by your doctor.

Verapamil for Migraine Prevention

Initial Dose: 80 mg to 120 mg orally, 3 times a day.

Maintenance Dose: 240 mg to 480 mg per day, divided into 2 or 3 doses.

Length of Treatment: As directed by your doctor.

Verapamil for Heart Failure

Initial Dose: 80 mg to 120 mg orally, 3 times a day.

Maintenance Dose: 240 mg to 480 mg per day, divided into 2 or 3 doses.

Length of Treatment: Long-term, as directed by your doctor.

Verapamil for Arrhythmias

Initial Dose: 240 mg to 320 mg per day, divided into 2 or 3 doses.

Maintenance Dose: 240 mg to 480 mg per day, divided into 2 or 3 doses.

Length of Treatment: Long-term, as directed by your doctor.

Verapamil for Coronary Artery Disease

Initial Dose: 80 mg to 120 mg orally, 3 times a day.

Maintenance Dose: 240 mg to 480 mg per day, divided into 2 or 3 doses.

Length of Treatment: Long-term, as directed by your doctor.

Verapamil for Tachycardia

Initial Dose: 240 mg to 320 mg per day, divided into 2 or 3 doses.

Maintenance Dose: 240 mg to 480 mg per day, divided into 2 or 3 doses.

Length of Treatment: Long-term, as directed by your doctor.

Dosage Forms and Strengths of Verapamil

Verapamil is available in several forms and strengths to accommodate different treatment needs:

1. Tablets: 40 mg, 80 mg, 120 mg
2. Extended-release tablets: 120 mg, 180 mg, 240 mg
3. Extended-release capsules: 100 mg, 120 mg, 180 mg, 200 mg, 240 mg, 300 mg
4. Injection: 2.5 mg/mL

Contraindications for Verapamil

Contraindications are specific conditions where a medication should not be used because it may cause harm. If you have any of the following conditions, Verapamil may not be safe for you. Always consult your healthcare provider before starting any new medication, especially if you have any of the following:

1. Severe left ventricular dysfunction: Verapamil can further reduce the heart’s ability to pump blood, worsening heart failure.
2. Hypotension (low blood pressure): Since Verapamil lowers blood pressure, taking it when your blood pressure is already low can lead to dangerous drops.
3. Second- or third-degree atrioventricular (AV) block: Verapamil slows electrical signals in the heart, which can worsen these types of heart block and lead to serious complications.
4. Sick sinus syndrome (without a pacemaker): Verapamil can slow the heart rate, which may worsen this condition unless a pacemaker is in place.
5. Severe bradycardia (slow heart rate): Verapamil can further slow the heart rate, which can be dangerous for individuals with an already slow heart rate.
6. Hypersensitivity to Verapamil: If you have had an allergic reaction to Verapamil in the past, you should not take it again, as it could cause a severe allergic reaction.

Drug to Drug Interactions

Verapamil can interact with other medications, potentially increasing side effects or reducing the effectiveness of either drug. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Some known Verapamil interactions include:

1. Beta-blockers: Medications like Metoprolol (Lopressor) and Atenolol (Tenormin) can increase the risk of a slow heart rate or low blood pressure when combined with Verapamil.
2. Digoxin (Lanoxin): Verapamil can raise Digoxin levels in the blood, which may lead to toxicity.
3. Statins: Drugs like Simvastatin (Zocor) and Lovastatin (Mevacor) may have increased blood levels when taken with Verapamil, raising the risk of muscle damage (rhabdomyolysis).
4. Antiarrhythmic drugs: Amiodarone (Pacerone) and Quinidine (Quinidex) can interact with Verapamil, increasing the risk of heart rhythm disturbances.
5. Antihypertensives: Medications like Lisinopril (Zestril) and Losartan (Cozaar) may have an additive effect with Verapamil, potentially leading to excessively low blood pressure.
6. Grapefruit juice: Although not a medication, grapefruit juice can increase Verapamil levels in the bloodstream, heightening the risk of side effects.

Verapamil in Pregnancy

Is it safe to take Verapamil during pregnancy?

Verapamil is classified as a pregnancy category C drug by the FDA. This means there is not enough well-controlled research in humans to determine its safety during pregnancy. While animal studies have shown some risk to the fetus, the potential benefits may outweigh the risks in certain situations. If you are pregnant or planning to become pregnant, it’s essential to discuss the risks and benefits of Verapamil with your healthcare provider. Together, you can weigh the potential risks to the baby against the benefits of managing your condition.

Verapamil while Breastfeeding

Is it safe to take Verapamil while breastfeeding?

Verapamil does pass into breast milk, but the amounts are generally considered small. However, since the effects on a nursing infant are not fully understood, it’s important to consult your healthcare provider if you are breastfeeding. In some cases, alternative medications may be recommended, or you may be advised to monitor your baby for signs of side effects, such as unusual sleepiness or poor feeding.

Estimated Cost of Verapamil Medication

The cost of a 30-day supply of Verapamil can vary depending on the dosage and the pharmacy. Without insurance, the price using a GoodRX coupon typically ranges from $10 to $20 for generic Verapamil. Brand-name versions, such as Calan or Verelan, may be more expensive, ranging from $50 to $100 or more. Be sure to check with your pharmacy for the most accurate pricing.

Possible Alternatives to Verapamil

If Verapamil is not suitable for you, there are alternative treatments and lifestyle changes that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss your options.

1. Hypertension (High Blood Pressure): Alternatives include ACE inhibitors (Lisinopril), ARBs (Losartan), or lifestyle changes such as reducing salt intake, increasing physical activity, and managing stress.
2. Angina (Chest Pain): Beta-blockers (Metoprolol), nitrates (Nitroglycerin), and lifestyle changes like quitting smoking and regular exercise can help manage angina.
3. Atrial Fibrillation: Alternatives include anticoagulants (Warfarin), beta-blockers, or catheter ablation. Lifestyle changes such as reducing alcohol intake and managing stress may also help.
4. Supraventricular Tachycardia (SVT): Beta-blockers or catheter ablation may be considered. Reducing caffeine and alcohol intake can also help prevent episodes.
5. Cluster Headaches: Alternatives include oxygen therapy, triptans (Sumatriptan), or preventive medications like corticosteroids. Avoiding known triggers, such as alcohol, may also help.
6. Migraine: Beta-blockers, anticonvulsants (Topiramate), and lifestyle changes like maintaining a regular sleep schedule and avoiding triggers can be effective.
7. Heart Failure: ACE inhibitors, beta-blockers, and diuretics (Furosemide) are common alternatives. Lifestyle changes such as reducing sodium intake and managing fluid retention are also important.
8. Arrhythmias: Beta-blockers, antiarrhythmic drugs (Amiodarone), or procedures like cardioversion may be considered. Avoiding stimulants like caffeine can help manage symptoms.
9. Coronary Artery Disease: Statins, aspirin, and lifestyle changes like quitting smoking, eating a heart-healthy diet, and exercising regularly can help manage this condition.
10. Tachycardia: Beta-blockers, antiarrhythmic drugs, or lifestyle changes like reducing caffeine intake and managing stress may help control a fast heart rate.

Recent Updates on Verapamil Research

Recent research on Verapamil has explored its potential use beyond cardiovascular conditions. Some studies have investigated its role in treating conditions like diabetes and certain neurological disorders. For instance, a 2021 study suggested that Verapamil might help preserve beta-cell function in individuals with type 1 diabetes, potentially slowing disease progression. Additionally, ongoing research is examining Verapamil’s potential in treating certain cancers, as it may enhance the effectiveness of chemotherapy drugs. However, these uses are still experimental, and more research is needed before Verapamil can be recommended for these conditions.

Always consult your healthcare provider before considering any new or experimental treatments. If you have questions about Verapamil or other medications, you can schedule a telemedicine appointment with one of our providers to discuss your concerns.

James Kingsley

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